After September 30, Senate Republicans will no longer be able repeal, replace, or otherwise alter Obamacare with a simple majority vote. For all intents and purposes, that means they have exactly 12 days to keep a solemn promise they have repeatedly made to the voters. Beginning in October, any meaningful change to the “Affordable Care Act” will require the cooperation of the Democrats, who have pledged to filibuster any bill that fails to bail out the imploding health care law. That leaves the GOP with precisely one realistic option — pass the Graham-Cassidy-Heller-Johnson (GCHJ) bill before the end of the month.
GCHJ, which was unveiled in the Senate last Wednesday by Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI), is by no means perfect of course. But the legislation, more accurately an amendment “in the nature of a substitute” to the American Health Care Act of 2017, is infinitely better than the Obamacare status quo. Nonetheless, it is already drawing criticism from the usual self-serving suspects. Kentucky Senator Rand Paul, for example, once again trotted out his hopelessly tired and inaccurate “Obamacare Lite” talking point in a Friday tweet.
Which brings us to a fact of life that must be faced before getting into the details of GCHJ. If people like Senator Paul really want to do something about Obamacare, it is imperative that they face their actual choices. Much of the internal GOP debate on repeal has been characterized by magical thinking on this point. An obvious example is the “full repeal” fantasy. Full repeal in one fell swoop isn’t going to happen. Without a filibuster-proof majority, the GOP is immured by the rules of budget reconciliation, meaning that any legislation involving Obamacare can only alter provisions with a direct budgetary impact.
And it’s ridiculous to demand that Senate Majority Leader Mitch McConnell eliminate this obstacle by “going nuclear” on the filibuster. Neither the American Health Care Act (AHCA) nor the Better Care Reconciliation Act (BCRA) were defeated by the Democrats. Both failed because Republican Senators like Rand Paul and John McCain cast critical “No” votes based on transparently phony principles or the petty desire to wreak revenge on the President because he was mean to them during the 2016 GOP primaries. If these people are really serious about rolling back Obamacare, they will get behind GCHJ.
Again, GCHJ is far from perfect, but it would do a lot of good. It would repeal the individual mandate and employer mandates, repeal the medical device tax, create a new association health plan option for small employers and self-employed individuals, increase the annual tax free contribution limit for Health Savings Accounts, allow states to require work as a condition of Medicaid eligibility for able-bodied adults, and eliminate the scandalous fiscal favoritism now enjoyed by Democrat-controlled states under Obamacare. Haven’t heard about that scam? At Forbes, Avik Roy provides a succinct explanation:
One of the most interesting reforms in Graham-Cassidy is that, over time, it ends a significant bias in the Medicaid program toward wealthy states like California, Massachusetts, New York, and Maryland. Medicaid is jointly funded by the federal government and the states; on average, Washington foots about 60 percent of the bill. In theory, the federal government is supposed to foot higher proportions of the bill for poorer states; but because the minimum match is set to 50 percent, a number of very wealthy states receive a lot more money than they should.
GCHJ would also repeal parts of Obamacare to which pro-life voters strongly object. The Family Research Council and the Susan B. Anthony List strongly endorse the bill because it would revive the principles, largely abandoned by the Obama administration, associated with the Hyde Amendment. The bill would, in other words, eliminate the use of federal tax dollars to promote abortion and subsidize organizations like Planned Parenthood. Family Research Council President Tony Perkins and Susan B. Anthony List President Marjorie Dannenfelser released the following joint statement in support of GCHJ:
We applaud Senators Graham and Cassidy for their leadership and strongly endorse the bill they have crafted. This legislation offers Republicans the best chance to fulfill their promises to repeal and replace Obamacare, stop taxpayer funding of abortion, and redirect tax dollars away from the nation’s largest abortion business, Planned Parenthood, to comprehensive health care alternatives. It is now well past time for Republicans in Congress to deliver on those promises. The Graham-Cassidy bill offers them the best chance to do that… before the September 30 deadline.
These two organizations do not, of course, exhaust the endorsements received by the GCHJ. One of the most important features of the bill involves its proposed use of block grants. As Senator Cassidy’s website phrases it, “The Graham-Cassidy-Heller-Johnson (GCHJ) proposal repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states to help individuals pay for health care.” This obviously removes much of the power over our health care exercised by our Beltway overlords. And this is precisely why former Federal Reserve chairman Alan Greenspan has endorsed it:
I applaud Senators Graham, Cassidy, Heller and Johnson’s creative, new approach to delivering health care to the American people. I have long believed a block grant approach empowering states to deliver health care consistent with their needs will provide better outcomes for patients and, most importantly, will be more fiscally sustainable.… Getting money and decision-making out of Washington and into the hands of governors who are legally bound by balanced budget amendments in their state constitutions is a giant step forward.
Thus, in GCHJ, the Senate has a replacement bill whose provisions make more sense than Obamacare from the perspectives of economics, morality, and equitable distribution of health care resources among the citizenry. Moreover, the meter is running and there is no viable alternative. If GCHJ doesn’t pass, America loses and the Democrats may well retake Congress in 2018. Surely, even the Republicans can figure out what they need to do here. As the proponents of Obamacare put it in 2010… PASS.THE.DAMN.BILL.